Korean J Crit Care Med.  2017 Nov;32(4):333-339. 10.4266/kjccm.2016.00787.

Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage

Affiliations
  • 1Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. seokrany@pusan.ac.kr
  • 2Department of Emergency Medicine, Pusan National University School of Medicine, Yangsan, Korea.

Abstract

BACKGROUND
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
METHODS
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
RESULTS
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
CONCLUSIONS
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Keyword

factor VIIa; maternal death; organ dysfunction scores; postpartum hemorrhage; recombinant proteins

MeSH Terms

Emergency Service, Hospital
Factor VIIa*
Female
Humans
Maternal Death
Maternal Mortality
Medical Records
Organ Dysfunction Scores
Postpartum Hemorrhage*
Postpartum Period*
Prognosis
Recombinant Proteins
Retrospective Studies
Factor VIIa
Recombinant Proteins
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